Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website http://www.cardiologyres.org

Review

Volume 11, Number 2, April 2020, pages 76-88

An Update on the Pathophysiology and Treatment of Cardiorenal Syndrome

Figures

Figure 1.
Figure 1. Mechanism of damage in CRS-1. ACE, angiotensin-converting enzyme; CKD, chronic kidney disease; CRS, cardiorenal syndrome; RAA, rennin-angiotensin-aldosterone.
Figure 2.
Figure 2. Mechanism of damage in CRS-2. CKD, chronic kidney disease; CRS, cardiorenal syndrome.
Figure 3.
Figure 3. Mechanism of damage in CRS-3. CRS, cardiorenal syndrome; GFR, glomerular filtration rate; RAAS, renin-angiotensin-aldosterone system.
Figure 4.
Figure 4. Mechanism of damage in CRS-4. CKD, chronic kidney disease; CRS, cardiorenal syndrome; EPO, erythropoietin; LDL, low-density lipoprotein.
Figure 5.
Figure 5. Mechanism of damage in CRS-5. CRS, cardiorenal syndrome.

Tables

Table 1. Classification of Cardiorenal Syndrome With Causes of Morbidity
 
Cardiorenal typesCharacteristicsCauses of morbidity
Type 1 (acute cardiorenal)Acute cardiac impairment leading to acute kidney injury (AKI)Cardiogenic shock and AKI, acute decompensated heart failure (ADHF) resulting in AKI
Type 2 (chronic cardiorenal)Chronic cardiac impairment leading to renal impairmentChronic heart failure
Type 3 (acute renocardiac)AKI leading to cardiac impairmentHeart failure in the setting of AKI from volume overload, inflammatory surge and accompanying metabolic disturbances
Type 4 (chronic renocardiac)Chronic kidney disease (CKD) leading to cardiac impairmentMyocardial remodeling and heart failure from CKD-associated cardiomyopathy
Type 5 (secondary cardiorenal)Systemic condition leading to both cardiac and renal impairmentDiabetes, amyloidosis and sepsis

 

Table 2. Biomarkers of Cardiac and Renal Dysfunction
 
BiomarkersCharacteristics of presentation/site of origin
Molecular biomarkers
  Cardiac troponin I (cTnI)Myocardial injury
  B-type natriuretic peptide (BNP)Myocardial stretching
  sST2Member of interleukin (IL)-1 family of receptors
  Indoxyl sulfateExtracellular signal-regulated kinase (ERK), p38 mitogen-activated protein kinase (MAPK) and nuclear factor-kappa B (NF-κB)
  N-terminal propeptide of type III collagen (PIIINP)Connective tissue injury
Physiological biomarkers
  EchocardiogramAbnormal left ventricular hypertrophy
Central venous pressure
Pericardial effusion
Valvular stenosis
Myocardial injury
Fluid overfill
Valvular calcification
  DopplerIntraparenchymal blood flow that is associated
  UltrasoundFluid overload
  Chest radiographCardiomegaly
Interstitial edema
Enlarged pulmonary artery
Pleural effusion
Prominent superior vena cava
Kerley line
Kidney biomarkers
  Serum creatinineSkeletal muscle
  AlbuminuriaMarker of glomerular integrity/procalcitonin (PCT) disruption
  Kidney injury molecule (KIM-1)Type 1 cell membrane glycoprotein expressed in regenerating PCT epithelium
  Liver type fatty acid binding proteinTubular injury
  IL-18Cytokine mediating inflammation and AKI through the NF-κB pathway
  Advanced glycation end products (AGE)Improper renal clearance, myoc
Physiological biomarkers
  UltrasoundKidney enlargement
Thin and hyperechogenic cortex
Small dilation of the urinary tract
Parapelvic and subcortical cysts
  DopplerIntraparenchymal blood flow